56years old female with H/o sudden loss of consciousness 6 hours back,At present on ventilator support and GCS is E1VTM2,minimal with both pupils dilated.How to proceed further with this case???

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CT shows left gangliocapdular bleed with IVH, gross cerebral edema and midline shift. CT doesn’t show significant ventriculomegaly or hydrocephalus. Prognosis for such bleed is uniformly poor. DeCompressive hemicraniectomy is and option however EVD can be attempted prior to that. NOK of the patient must be counselled regarding poor outcome even after intervention. AEDs Cerebral decongestants Other supportive measures to continue

Big bleed lt thalamo-ganglionic area with bood in the 3rd ventricle with uncal herniation, blood in the 4th ventricle &brainstem.small hyperintense lesion rt parietal area also..Suggest anticerebral edema measures. Urgent Neurosurgical opinion. Location of bleed suggestive of hypertensive bleed

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If both pupils are dilated fixed there's not going to be a good outcome whatever you may try Counsel the family with dot consent before proceeding with decompression if that is the plan. But I would not suggest that the surgeon should attempt this.

ventriculomegaly with intraventricular bleed in all chambers and cerebral atrophy.Suggestive of hypertensive intracranial bleed.

Left gangliocapsular bleed with intraventricular extension Conservative line of management: Ventilatory support Anticonvulsants Cerebral decongestants BP control Supportive management Considering the presenting neurological status prognosis is poor

Intracerebral HEMARRHAGE near Internal capsule.. + Reduction of ICT measures +Nimodipine slow infusion+Maintain ABC

Lt inyragangionic cerebral haematoma with intraventricular extension. Continue ABC with antioedema treatment and control BP if any to 150 /90 but not less .Evacuation of blood may be done but prognosis is poor whether to attempt surgical evacuation of blood or continue conservative treatment.

Neuro surgeon opinion.if ICP raised mannitol.control bp. Traneximic acid. Mid line shift than decompressive craniotomy.

HT bleed with IV extension and mild midline shift to right

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